Forms and Formats

Forms and formats for various NHM related activities are given below.

Click on the links to view/download respective forms/formats

Block Level Review of NHM Activities

1. Guidance Note 
2. Financial Review Template

ASHA Grievance Redressal:

1. ASHA Grievance Redressal Form
2. ASHA Monthly Reporting Format
3. Ward Health Report

Human Resource Related:

1. Watermark Page
2. Employee Identity card format
3. NLC Format
   
4. Leave Format
5. Transfer Form
6. New Leave Circular
7. Special Casual Leave
8. New Transfer Order Guidelines
9. Maternity Leave 182 days Circular
10. Maternity Leave 84 days Circular
11. General Leave Circular
12. 20 days Casual Leave Circular
13. Public Leave- New Circular
    
14. Earned Leave for Contract Staff
15. Employees Onboard checklist
    
16. BeneficiaryForm
    
17. Fund Request Form
18. TA Form
19. Form of Undertaking 
20. ESI Form
21. EPF Form
22. EPF Declaration Form
23. Agreement Form II III  & IV
24. Lok Ayukta asset and liabilities format
25. COVID 19 Contact Staff Agreement
26. COVID 19 Daily wages staff Agreement
27. MLSP Job Responsibilities

Finance Related Formats:

1. Fund Request format - Perepherals
2. Fund Request format - Nodal Officers
3. Concurrent Audit Guidelines
4. Concurrent Audit Expression of Interest
5. SOE Formats for Major Hospitals 2021-22
6. SOE Format for CHC/PHC 2021-22
7. COVID SOE
8. SOE Formats for program officers 
9. Clerk Incentive Format
10. Beneficiary Form
11. Fund devolved 2019-20
12. Fund devolved 2020-21
13. Fund devolved 2021-22
14. Fund devolved 2022-23
15. Fund Devolved 2023-24
    
16. Fund Devolved 2024-25
17. SOE Format 2024-25
    

Community Based Assessment Checklist

1. CBAC Form

RBSK Related

• NHM Shalabham Card
• RBSK 4D's Condition
• Comprehensive Newborn Screening Protocol
• WIFS reporting format
• Pulse Oximetry Fail Form 

Palliative Related

1. NPHCE Monthly Reporting Format

Program Coordination Checklist:

1. Program Co-ordination Checklist

Quality Assurance Related:

1. Swachhta Pakhwada Guidelines 
2. Code blue team Formation Guidelines

Engineering Related:

1. Respiratory Triaging Station - Concept Note and Estimate
2. Hand washing Station -Concept Note and Estimate

Monthly Reports: PRO/PRO-LO

1. Monthly report - Institution PRO
2. PRO Consolidation Report  
3. PRO Consolidation Report 2020-21
4. PRO Consolidation Report 2021-22
5. PRO Consolidation Report 2022-2023
6. PRO Consolidation report 2023-24
   
7. PRO Consolidation Report 2024-25
   

RNTCP

1. Monthly Reporting Format 
2. DOT Provider Honorarium Form

Others:

1. Dengue Activity Report
2. Universal Screening Format
3. FHC details

Accredited Private Health Institutions

1. Accredited Private Institutions in Pathanamthitta